Bone screw system and method

ABSTRACT

An improved bone screw is disclosed which includes a shaft with distal portion having a threaded surface thereon, a sleeve having an opening which receives the shaft such that the shaft is able to move within the sleeve without moving the sleeve. A compressive device may be incorporated between the sleeve and the proximal portion of the shaft such that the compressive device forces the shaft and sleeve towards at least a portion each other, thereby maintaining the compressive load at the union of the fracture. As additional compression is exerted on the load from weight bearing, the force may be reduced, but the head of the sleeve is still substantially maintained against the lateral cortex.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application is continuation of, claims priority to and the benefitof, U.S. Ser. No. 11/952,715 filed Dec. 7, 2007 and entitled “BONE SCREWSYSTEM AND METHOD.” The '715 application is a continuation-in-part of,and claims priority to and the benefit of, U.S. Ser. No. 11/742,457,filed on Apr. 30, 2007 and entitled “CANNULATED BONE SCREW SYSTEM ANDMETHOD,” which issued as U.S. Pat. No. 8,702,768 on Apr. 22, 2014. The'457 application is a continuation-in-part of, and claims priority toand the benefit of, U.S. Ser. No. 11/678,473, filed on Feb. 23, 2007 andentitled “SYSTEM AND METHOD FOR A CAP USED IN THE FIXATION OF BONEFRACTURES,” which issued as U.S. Pat. No. 8,679,167 on Mar. 25, 2014.The '473 application is a continuation-in-part of, and claims priorityto and the benefit of, U.S. Ser. No. 10/779,892, filed on Feb. 17, 2004and entitled “SYSTEM AND METHOD FOR THE FIXATION OF BONE FRACTURES,”which issued as U.S. Pat. No. 7,591,823 on Sep. 22, 2009. The '892application is a continuation of, claims priority to and the benefit of,U.S. Ser. No. 10/272,773, filed on Oct. 17, 2002 and entitled “SYSTEMAND METHOD FOR FIXATION OF BONE FRACTURES,” which issued as U.S. Pat.No. 6,736,819 on May 18, 2004. The '773 application claims priority toand the benefit of U.S. Provisional Application Ser. No. 60/330,187,filed on Oct. 18, 2001 and entitled LAGWIRE SYSTEM AND METHOD. All ofthe above-mentioned patents and applications are incorporated herein byreference.

FIELD OF INVENTION

The invention generally relates to a system and method for the fixationof fractures in one or more objects, which may be separate objects orseparate object portions or fragments of the same object, and moreparticularly, to a bone screw for the fixation of bone fractures whichcollapses along with the fracture collapse to minimize protrusion of thedevice beyond the bone surface, and to maintain compression across thefracture during fracture collapse.

BACKGROUND OF THE INVENTION

It is well-known in the medical arts that constant pressure on a bonefracture speeds healing. As such, orthopedic physicians typically insertone or more screws in the area of the fracture in order to assertconstant pressure on the bone fracture. However, the insertion ofexisting screws through or around fractures has disadvantages. Forexample, the entire process is very time-consuming because inserting aregular screw usually involves multiple steps such as drilling the pilothole, measuring the relevant distances to determine the appropriatescrew selection, tapping the hole to establish threads and screwing thescrew into the hole. Moreover, when using a bone screw, the processusually includes even more steps such as drilling through the nearcortex to establish the guiding hole (e.g., 3.5 mm), placing the drillguide in the proper location, drilling through the far cortex (e.g., 2.5mm), measuring the distance to determine the appropriate screwselection, tapping the hole to establish threads and rotating the screwinto the hole, thereby attempting to compress the fracture. Again, eachstep and the entire process is very time-consuming.

In addition to the length and complexity of the process, the prior artsystem also typically includes inadequate components. For example, inpoor bone, prior art screws often loose their grip and strip out of thebone. Currently available bone screws also typically provide only oneside of cortex fixation and are generally not suited for percutaneoussurgery. Moreover, when placing the screws in the bone, the physicianmay not accurately set the screw into the distal hole or may miss thedistal hole completely, thereby resulting in the screw stripping thethreads or breaking the bone.

Furthermore, the location and extent of most every fracture is unique,so different screws are often needed for each fracture. Because thephysician typically is unable to accurately determine the type or sizeof screw needed until the physician enters the bone and measures theappropriate screw placement, operating facilities need to store and makeavailable large inventories of screws. Particularly, screws usuallyrange in length from about 10 mm to about 75 mm with available screwsizes limited to every 2 mm there between. Moreover, for each size ofscrew, the screws may be either a cancellous or cortical type, and foreach size and type of screw, the screw may include one of threedifferent pitches. Accordingly, a screw set typically exceeds onehundred screws. Furthermore, if cannulated screws are desired, anotherentire screw set of over one hundred additional screws is often needed.Moreover, each time a screw from a screw set is utilized in a procedure,a replacement screw is typically obtained to complete the set. As such,inventory management of screws is a very large problem for manyoperating facilities. A need exists for a lagwire system whichsimplifies and expedites the process for the fixation of bone fractures,while minimizing the number of components needed in the process.

Additionally, in hip fractures (e.g. femoral neck fracture), thenon-union rate is about 25-30%. Certain factors may contribute to thenon-union rate in fractures such as, for example, poor blood supply andage of patient. However, an important factor for the non-union rate infractures is micro-motion. Micro-motion of the hip bones is typicallycaused by the natural movements of the patient while the patient iswalking, hopping on crutches, twisting and the like. Such micro-motionhas an affect on the bone screw in that the micro-motion often causesthe bone screw to slide within the bone, thereby disrupting the boneunion. The bone union is disrupted because the union loses its fixedcompression and fracture interface is decompressed.

Another concern with bone screws is that the head of bone screw oftenprotrudes out of the bone surface over time. In particular, when a bonefracture is set with a bone screw, the bone screw typically does notcompletely compress the bone together. As such, after the patient standsand a weight bearing force is applied against the bone (or any othercompressive forces applied to the bone), the bone is further compressed.The further compression of the bone or its portions or fragments resultsin the head of the bone screw (which was previously flush with theoutside surface of the bone) protruding outside from the surface of thebone. In some cases, the head of the bone screw may protrude about 1 cmwhich may result in pain and/or the need for additional surgery. A needexists for a device and method for maintaining the initial andsubsequent compression of a bone fracture to increase the union rate ofthe bone fracture.

SUMMARY OF THE INVENTION

In general, the invention facilitates the fixation of bone fractures. Inone embodiment, a head or anchor component includes a tip, cuttingthreads and mating threads which are inserted into the far cortex of thebone. A wire extends from the anchor component and exits from the nearcortex.

A cap device fits over the other end of the wire such that the capdevice permits travel of the cap in one direction (e.g., distal travelwith respect to the wire), but resists travel of the cap in the otherdirection (e.g., proximal travel with respect to the wire). In oneembodiment, a cap device having a sawtooth inner surface is threadedover the wire having an inverse sawtooth outer surface such that the capis restricted from backwards movement. In another embodiment, the capincludes a circular tension spring inside the cap such that the wire isreceived within a central opening within the circular tension spring.The tension spring also includes a nub extending from the outercircumference of the tension spring such that a portion of the innercircumference of the tension spring provides friction against the wireonly one way (when the cap is pulled proximal, away from the bone). Thefriction is asserted against the wire because the nub on the side of thetension spring hits the top circular cap, so it forces the tensionspring to flex and assert friction on the wire. When the cap is pushedthe other way (e.g., when the cap is pushed distal, toward the bone) thenub of the tension spring is forced down, so it does not engage anysurface, and the wire is able to translate, with minimal or no friction,through the central opening in the tension spring.

Tension is then applied to the wire while the cap is tightened againstor within the bone surface to thereby apply an appropriate amount ofpressure between the surfaces of the fracture. The excess wire beyondthe cap can then be removed.

The invention also includes a system for facilitating a change indistance between objects, or object portions, wherein the systemincludes a anchor component configured to attach to one of the objects;a wire having a first end and a second end, wherein the first end of thewire is configured to mate with the anchor component; and, a capconfigured to mate with the second end of the wire. The invention alsoincludes a method for facilitating a change in distance between a firstand second surface The method includes providing a anchor componentmated with a wire having a first interface component; inserting theanchor component into the first surface by mating a drill over a driverhead of the anchor component to facilitate drilling the anchor componentinto the bone and cutting new threads into the object using the cuttingthreads and mating the new threads with the mating threads; extendingthe wire through the second surface; threading a cap having a secondinterface component over the first interface component of the wire; andremoving the excess wire beyond the cap.

In another embodiment, the invention includes a shaft with distalportion having a threaded surface thereon, a sleeve having an openingwhich receives the shaft such that the shaft is able to move within thesleeve with minimal or no movement of the sleeve. In one embodiment, acompressive device (e.g., spring, split washer, sponge, rubber bumper,resilient material or mechanism, etc.) may exist between the sleeve andthe proximal portion of the shaft such that the compressive deviceexerts a force directly or indirectly against the shaft and the sleeve.In one embodiment, the compressive device is located inside the sleeve.The compressive device exerts a force which serves to move the distalhead and the proximal sleeve toward each other, thereby maintaining thecompressive load at the union of the fracture. As additional compressionis exerted on the fracture from weight bearing, the force may bereduced, but the head of the sleeve is still substantially maintainedagainst the lateral cortex and the proximal portion of the shaft isstill substantially maintained within the sleeve. The sleeve may bemaintained against or within the lateral cortex until sufficientcollapse of the fracture occurs such that the compressive device nolonger exerts a force against the sleeve or shaft, then the device maysimply act as a traditional bone screw. As such, the improved bone screwof the present invention minimizes or prevents the device fromprotruding beyond the bone, and maintains the compression across thefracture during fracture collapse. The bone screw of the presentinvention may be used in place of any existing bone screw, or anyexisting component of a product that performs a similar function as abone screw.

BRIEF DESCRIPTION OF THE DRAWINGS

A more complete understanding of the present invention may be derived byreferring to the detailed description and claims when considered inconnection with the figures, wherein like reference numbers refer tosimilar elements throughout the figures, and:

FIG. 1A is a lagwire system including a anchor component and wire inaccordance with an exemplary embodiment of the present invention.

FIG. 1B is a lagwire system illustrating various thread combinations asembodiments of the present invention.

FIG. 2A is a quick cap in accordance with an exemplary embodiment of thepresent invention.

FIG. 2B is an alternative embodiment of a quick cap in accordance withan exemplary embodiment of the present invention.

FIG. 2C is a screw cap in accordance with an exemplary embodiment of thepresent invention.

FIG. 2D is a flat cap in accordance with an exemplary embodiment of thepresent invention.

FIG. 2E is a top view of an alternative embodiment of a cap inaccordance with an exemplary embodiment of the present invention.

FIG. 2F is a perspective view of another embodiment of a cap inaccordance with an exemplary embodiment of the present invention.

FIG. 2G is a top view of an exemplary spring in accordance with anexemplary embodiment of the present invention.

FIG. 2H is an exploded perspective view a cap in accordance with anexemplary embodiment of the present invention.

FIG. 2I is a perspective view of the embodiment of the cap of FIG. 2H,fully assembled.

FIG. 2J is a cross section view of the embodiment of the cap shown inFIG. 2I.

FIG. 3A is a tensioner in accordance with an exemplary embodiment of thepresent invention.

FIG. 3B is another embodiment of a tensioner in accordance with anexemplary embodiment of the present invention.

FIG. 4A is a fixation of a bone fracture in accordance with an exemplaryembodiment of the present invention.

FIGS. 4B-4D are fixations of fractures of a certain portions of a bonein accordance with an exemplary embodiment of the present invention.

FIG. 4E is a fixation of a bone fracture by inserting the lagwirethrough the entire limb to facilitate attaching an external fixationdevice to the limb in accordance with an exemplary embodiment of thepresent invention.

FIGS. 4F-4G is a fixation of a bone fracture by inserting the lagwirethrough the entire limb to facilitate holding a plate to the bone tohelp fix certain types of fractures in accordance with an exemplaryembodiment of the present invention.

FIG. 4H is a fixation of a spinal injury in accordance with an exemplaryembodiment of the present invention.

FIG. 5A is an exemplary head of the extractor of FIG. 5B in accordancewith an exemplary embodiment of the present invention.

FIG. 5B is an exemplary extractor in accordance with an exemplaryembodiment of the present invention.

FIG. 5C is another embodiment of an exemplary extractor in accordancewith an exemplary embodiment of the present invention.

FIG. 6 is an exemplary cutter in accordance with an exemplary embodimentof the present invention.

FIG. 7 is a cannulated screw having a sleeve and a threaded shaft inaccordance with an exemplary embodiment of the present invention.

FIG. 8 is a cannulated screw having a sleeve, a compressive device and athreaded shaft and shown prior to extending the compressive device, inaccordance with an exemplary embodiment of the present invention.

FIG. 9 is a cannulated screw having a sleeve, a compressive device and athreaded shaft and shown after extending the compressive device, inaccordance with an exemplary embodiment of the present invention.

FIG. 10 shows multiple cannulated screws providing rotational stabilityto a fracture, in accordance with an exemplary embodiment of the presentinvention.

FIG. 11 shows a cannulated screw received through an intermedulary rod,in accordance with an exemplary embodiment of the present invention.

FIG. 12 shows a cannulated screw with a sleeve and a barrel as part of ahip screw plate system, in accordance with an exemplary embodiment ofthe present invention.

FIG. 13 shows another embodiment of a cannulated screw wherein thebarrel functions as the sleeve, as part of a hip screw plate system, inaccordance with an exemplary embodiment of the present invention.

FIG. 14 is a sleeve and a bone screw capable of receding within thesleeve in accordance with an exemplary embodiment of the presentinvention.

FIG. 15 is a cross section view of the sleeve and bone screw of FIG. 14.

FIG. 16 is a perspective view of the sleeve and bone screw of FIGS. 14and 15 shown with the bone screw recessed within the sleeve inaccordance with an exemplary embodiment of the present invention.

FIG. 17 is a cross section view of the bone screw recessed within thesleeve of FIG. 16.

DETAILED DESCRIPTION

The present invention is described herein and includes various exemplaryembodiments in sufficient detail to enable those skilled in the art topractice the invention, and it should be understood that otherembodiments may be realized without departing from the spirit and scopeof the invention. Thus, the following detailed description is presentedfor purposes of illustration only, and not of limitation, and the scopeof the invention is defined solely by the appended claims. Theparticular implementations shown and described herein are illustrativeof the invention and its best mode and are not intended to otherwiselimit the scope of the present invention in any way.

In general, the present invention facilitates the change in distancebetween objects, object portions, or surfaces, compresses objects orobject portions together, and/or provides a configurable or randomamount of pressure between surfaces. The system may facilitate changing,maintaining, reducing and/or expanding the distance between objects orobject portions. The applied pressure may be suitably configured to beconstant, increasing, decreasing, variable, random, and/or the like. Inan exemplary embodiment, the invention includes a device which may befixedly or removably attached to pathology, such as to a certain portionof a bone. In a particular embodiment, the device is fixedly orremovably attached to the far cortex of the bone. In another embodiment,the invention includes a device or method for retracting the attacheddevice to reduce the distance between the surfaces of the pathology. Ina further embodiment, the invention includes a device and/or method formaintaining the pressure between the surfaces of pathology.

In an exemplary embodiment, and as shown in FIGS. 1 and 2, the lagwiresystem 1 includes a head or anchor component 2, a wire 12 and a cap 20.The lagwire system 1 may be fabricated using any type, amount orcombination of materials suitably configured for the particularapplication. In an exemplary embodiment for medical applications, thelagwire system 1 is fabricated with stainless steel, titanium and/ortitanium alloy which minimize reactivity with the body. Each componentmay be fabricated with various diameters, thread pitches, lengths and/orthe like. The anchor component 2 may include threads, fins, tines, orany other fixation device or structure capable of securing the anchorcomponent 2 to an object. Wire 12 may form any cross-sectional shape,width, thickness, diameter, and surface features along its length, andthus, for example, may form a simple cylinder and/or may include ribs,threads, serrations, one or more flat surfaces, bumps, and/or roughenedsurfaces along its length.

Certain exemplary components of the system will now be discussed. Theanchor component 2 is any device which is configured to fixedly orremovably attach to any object, such as pathology. In a particularembodiment, the anchor component 2 is configured to be fixedly orremovably attached to the far cortex of the bone, as shown in FIGS.4A-4G. As best shown in FIG. 1A, the anchor component 2 may include, forexample, a self drilling tip 4 device which is suitably configured topuncture a hole and/or guide the anchor component 2, self cuttingthreads 6 which are suitably configured to cut thread grooves into theinside surface of a hole, fastening threads 8 which are suitablyconfigured to mate with the newly formed thread grooves, and a toolattachment 10 suitably configured for mating with a tool head (e.g., hexhead wrench, socket wrench, Phillips screwdriver, flathead screwdriver,allen wrench and/or the like).

Anchor component 2 may include different and interchangeable threadconfigurations, lengths, diameters, pitches and the like to facilitateinsertion into different types of bone or other structures (e.g.,cortical bone, cancellous bone, etc). Similarly, cap 20 may includedifferent thread configurations, lengths, diameters, pitches and thelike to facilitate insertion into different types of bone or otherstructures. For example, both the anchor component 2 and/or cap 20, maybe interchangeably removed and replaced by different anchor components 2and caps 20 with different thread configurations. Alternatively, theanchor component 2 may not be removable from the remainder of the wire12.

Examples of such thread configurations are illustrated in FIG. 1B andmay be adapted for insertion into various bone or other structures. Inone embodiment, the anchor component 2 includes leading threads 280accommodating insertion into cortical bone while the cap 20 includestrailing threads 282 accommodating insertion into cortical bone. Inanother embodiment, the anchor component 2 includes leading threads 284accommodating insertion into cancellous bone while the cap 20 includestrailing threads 286 accommodating insertion into cancellous bone. Inanother embodiment, the anchor component 2 includes leading threads 280accommodating insertion into cortical bone while the cap 20 includestrailing threads 286 accommodating insertion into cancellous bone. Inanother embodiment, the anchor component 2 includes leading threads 284accommodating insertion into cancellous bone while the cap 20 includestrailing threads 282 accommodating insertion into cortical bone. Inanother embodiment, the anchor component 2 includes leading threads 280accommodating insertion into cortical bone while the cap 20 includestrailing threads 288 accommodating insertion a mechanical component suchas a plate anchored into bone. In another embodiment, the anchorcomponent 2 includes leading threads 284 accommodating insertion intocancellous bone while the cap 20 includes trailing threads 288accommodating insertion a mechanical component such as a plate anchoredinto bone. In another embodiment, the anchor component 2 includesleading threads 280 accommodating insertion into cortical bone while thecap 20 includes a low-profile button-like design 290 that butts againstthe bone or a mechanical component. In another embodiment, the anchorcomponent 2 includes leading threads 284 accommodating insertion intocancellous bone while the cap 20 includes a low-profile button-likedesign 290 that butts against the bone or a mechanical component. Inanother embodiment, the anchor component 2 includes leading threads 280accommodating insertion into cortical bone while the cap 20 includes alow-profile button-like design that butts against the bone or amechanical component and may also include spikes or teeth 292 to preventrotation of the cap 20. In another embodiment, the anchor component 2includes leading threads 284 accommodating insertion into cancellousbone while the cap 20 includes a low-profile button-like design thatbutts against the bone or a mechanical component and may also includespikes or teeth 292 to prevent rotation of the cap 20.

In another embodiment of a system 1, the cap 20 may be placed at bothends of the wire 12, and any combination of caps 20 threads oradditional features may be used as preferred by an operator of thesystem 1. For example, in one embodiment, a first cap 20 includescortical threads 282, cancellous threads 286, machine threads 288accommodating insertion a mechanical component such as a plate anchoredinto bone, a low-profile button-like design 290 that butts against thebone or a mechanical component, and/or spikes or teeth 292 to preventrotation of the first cap 20; and a second cap 20 includes corticalthreads 282, cancellous threads 286, machine threads 288 accommodatinginsertion a mechanical component such as a plate anchored into bone, alow-profile button-like design 290 that butts against the bone or amechanical component, and/or spikes or teeth 292 to prevent rotation ofthe second cap 20.

In a particular embodiment, the tip is on the front end of anchorcomponent 2, followed by the cutting threads 6, the fastening threads 8,the tool attachment 10, then wire 12. The elements of anchor component 2may be fabricated as one component or one or more elements may beconfigured to be removably or fixedly mated together to form anchorcomponent 2. If mated together, a particular element may be exchangedfor different applications. For example, if anchor component 2 needs tobe inserted into a dense or hard bone, a stronger or sharper tip 4 maybe screwed into thread element 6,8. Moreover, if deeper thread groovesare desired, cutting threads 6 may be replaced with greater diameterthreads. Furthermore, if a different tool head is incorporated into adrill, tool attachment 10 may be exchanged with the appropriateattachment.

In one embodiment, the outside diameter of the fastening threads aresimilar to the thread diameters of known surgical screw sizes. Exemplaryoutside diameters of cortical anchor components include 3.5 mm and 4.5mm, wherein the length of the thread section is similar to the cortexthickness. Exemplary outside diameters of cancellous (i.e., little or nocortex) anchor components include about 4.0 mm and 6.5 mm, wherein thelength of the thread section may be about 16 mm or 32 mm.

Wire 12 is any device suitably configured, when force is applied, toreduce the distance between two surfaces. In one embodiment, wire 12 isconfigured to retract the anchor component 2 device to reduce thedistance between the surfaces of the pathology. In one embodiment,anchor component 2 and wire 12 are constructed as one component. Inanother embodiment, anchor component 2 and wire 12 are constructed asseparate components, but the components are configured such that theanchor component 2 may be threaded onto wire 12 after wire 12 is placedinto the bone. Wire 12 further includes an interface component 14 on atleast a portion of its surface, wherein the interface component 14 issuitably configured to limit the movement of cap 20 to move distallytoward anchor component 2, but not proximally (backwards).

In an exemplary embodiment, interface component 14 of wire 12 includes asawtooth like configuration such that one side of each tooth (e.g. theside closest to anchor component 2) is substantially perpendicular tothe surface of wire 12, while the other side of the sawtooth is at asuitable angle, such as 45 degrees, thereby forming a triangular patternfor each sawtooth. In this manner, the inverse sawtooth on the insidesurface of the cap slides or bends over the angled side of the wiresawtooth, but the substantially perpendicular side of the wire sawtoothrestricts or limits the cap sawtooth from backwards movement. In anotherembodiment, any portion or the entire length of wire 12 includes anyconfiguration such as, for example, round, oval, flat on one or moreportions of the wire, and/or microgrooves or ridges along the wire(which may include the sawtooth configuration, indentions or otherconfigurations) to increase the friction along the wire. In oneembodiment, wire 12 holds 20 pounds of pull; however, microgrooves inthe wire may significantly increase the strength of the wire 12.

In an exemplary embodiment, wire 12 is comprised of a thin metal suchas, for example, stainless steel, titanium and/or titanium alloy, so itmay be easily cut to almost any desired length, thereby eliminating orreducing the need for fixed lengths screws. As such, the inventionsubstantially reduces or eliminates the need for the inventory oravailability of large screw sets or multiple screws. Moreover, becausethe system may include numerous materials, configurations and designsfor either wire 12 or cap 20, the invention provides increasedversatility because the physician is provided with multiple options andchoices for wire 12 and cap 20 combinations.

Cap 20 is any device suitably configured to maintain or increase thepressure between the surfaces of pathology by limiting wire 12 movement.As shown in FIGS. 2A-2E, exemplary caps 20 may include variousconfigurations, materials, shapes and/or sizes. In one embodiment, andas shown in FIG. 2A, cap 20 includes an inverse interface component 22relative to wire 12 interface component such that cap 20 is restrictedfrom backwards translation after cap 20 is inserted over wire 12. In oneembodiment, the interface component 22 on cap 20 is located at least onthe inside surface of the cap and includes a saw tooth pattern with thesame or similar pitch as the saw tooth on wire 12. This configurationalso allows cap 20 to slide along wire 12 without the need for spinningcap 20 which is important because time is of the essence in a medicalprocedure and spinning the cap down a sufficiently long length of wirewould be very time-consuming. Examples of cap 20 include a screw cap 20,flat cap 20 and a quick cap 20. As shown in FIG. 2C, screw cap 20 isconfigured with teeth 22, cutting threads 24 and/or mating threads 26 onthe outside surface to facilitate rotating cap 20 into the cortex to,for example, fix surgical plates against certain pathology. However,cutting threads 24 may not be needed on any of the caps because cuttingthreads 6 of anchor component 2 may have already tapped the threads onthe inside surface of the bone, so the teeth 22 or mating threads 26alone can simply rotatably engage the threads formed from cuttingthreads 6 and provide sufficient friction to secure the cap in the bone.As shown in FIG. 2D, flat cap 20 may include teeth 22, cutting threads24 and/or mating threads 26 on the outside surface to facilitaterotating cap 20 into the cortex, but it also is configured with a flattop surface 28 to allow cap 20 to be inserted into the cortex such thatthe flat top surface 28 of cap 20 does not substantially protrude fromthe cortex surface. As best shown in FIG. 2A, for example, the quick cap20 or any other cap may be configured with only the interface componenton the inside surface, thereby allowing for quick and easy assembly.

With reference to FIG. 2E, in one embodiment, cap 20 is configured as aplanar disk 30 with a center hole 32, wherein the center hole 32includes an interface component 34 on its inner circumference surface.In an exemplary embodiment, the pitch of the saw tooth interfacecomponent is about 0.25 mm-0.5 mm. The planar disk 30 may also includeany configuration for facilitating expansion of the disk 36 whilesliding down wire 12. The configurations may include, for example, a cut38 or a hole 36 in the planar disk 30. The planar disk may includemultiple holes or cuts spaced over the planar surface. One or more ofthe additional holes 36 may also be connected to a cut 38 in the planarsurface that extends to the center hole 32. One or more of the holes 36may also be connected to a cut 40 in the planar surface that extends tothe outside edge of the planar surface. In one embodiment, sixadditional holes 36 are evenly spaced around the planar surface witheach hole 36 connected to a cut 38 which extends to the center hole,while one hole 36 also includes a cut 40 that extends to the outsideedge of the planar surface.

The planar disk may also set inside a shallow cup device, wherein thecircumference of the cup is slightly larger than the circumference ofthe planar ring in order to allow expansion of the ring. Moreover, aspring, or any other device suitably configured to apply pressure to cap20, is placed between the planar ring and the cup device. In oneembodiment, a bellville spring is used to apply pressure to the cap 20.The spring is configured to provide force on wire 12 after resorption.During the healing process, cartilage forms at the fracture and thecartilage compresses, so bone resorption typically occurs at thelocation of the fracture. When force on the lagwire is released due tobone resorption during healing, in one embodiment, cap 20 allows forauto tightening of the lagwire because micro-motions or vibrations willoften cause cap interface device 22 to click down another notch on theinverse interface device of the wire 12.

Another embodiment of a cap 20 is shown in FIG. 2F. As discussed above,cap 20 fits over one end of wire 12, such that cap 20 permits travel ofcap 20 in one direction (e.g., distal travel with respect to the wire,toward the bone), but resists travel of cap 20 in the other direction(e.g., proximal travel with respect to the wire, away from the bone). Inexemplary embodiments, cap 20 includes cutting threads 26, cover 70, aspring 80 and substantially flat surfaces 76 around the circumference ofcap 20 to facilitate griping and/or turning cap 20. Cap 20 may beconfigured with a wider upper section which includes flat surfaces 76around its circumference, and a tapered lower section with a graduallyreducing diameter. Cutting threads 26 extend from the lower section. Cap20 may include different thread configurations, lengths, diameters,pitches and the like to facilitate insertion into different types ofbone or other structures (e.g., cortical bone, cancellous bone, etc).

Cover 70 may be integral with cap 20, or may be a separate componentwhich is permanently or temporarily set in, or affixed to, cap 20. Inone embodiment, cover 70 includes an opening 72 (e.g., in center ofcover 70) which receives wire 12 and an inlet 74 which is configured toreceive a component of extractor tool 90.

In one embodiment, tension spring 80 is set inside cap 20. In oneembodiment, and with reference to FIG. 2G, tension spring 20 sits withincap 20 below cover 70; is circular; includes opening 84 (e.g., in centerof circular ring) which receives wire 12; includes an outer ring 82 andan inner ring 83; includes a cut into, or non-connecting portion 86 of,outer ring 82 and/or inner ring 83; and/or includes a tab 88 whichextends outward from outer ring 82. Outer ring 82 and an inner ring 83may be one integrated ring, or two or more separate rings, which may notbe connected, or may be connected in any manner.

At least a portion of inner ring 83 (or any portion of innercircumference of tension spring 80) provides greater friction againstwire 12 one way (e.g., when the cap is pulled proximal, away from thebone). The friction is asserted against wire 12 because cover 70 impactstab 88, so tab 88 forces tension spring 80 to flex, torque and/or tilt(e.g., 15 degrees) opening 84, thereby causing at least a portion ofinner ring 83 to assert friction against at least a portion of wire 12.When cap 20 is pushed the other way (e.g., when the cap is pusheddistal, toward the bone, using extractor 90), tab 88 is forced away fromcover 70 and does not tilt, so it does not engage any surface, and thewire is able to translate, with minimal or no friction, through thecentral opening in the tension spring.

Another embodiment of a cap 20 is shown in FIGS. 2H, 2I, and 2J. FIG. 2Hshows and exploded view of an example of the cap 20 with a cover orrecessed nut 70, an angle or lever clutch 300, a tension spring 80, anda body 302. When assembled, as shown in the perspective view of FIG. 2Ior cross section view of 2J, the tension spring 80 resides within achamber of the body 302, between the body 302 and the cover 70. Thelocking lever clutch 70 also resides between the body 302 and the cover70, and is in movable contact with the spring 80. The spring 80 is aflat spring washer that applies a preloaded force to the lever clutch300, biasing the lever clutch 300 to skew to a plane that is notparallel with the plane of the spring 80. In its skewed state, the leverclutch 300 includes defines a hole 304 along a central axis 306 that isnot coaxial with a central axis 308 of the cap 20, and frictional edges310 defining a portion of the hole 304 are forced into frictionalcontact with one or more flat or rounded outer surfaces of a wire 12running along the axis 308 of the cap.

The tension spring 80 may, for example, be formed of a relatively thinlayer of nitinol or another resilient material. The lever clutch 300may, for example, be formed of a thicker layer of stainless steel ortitanium. The relatively thin layer of the tension spring 80 occupiesminimal space within the chamber of the body 302, minimizing the overallsize of the cap 20. The relatively thick layer of the lever clutch 300provides greater surface area and strength to maximize stable and strongfrictional contact and lock between the frictional edges 310 and theouter surface of the wire 12. In an exemplary embodiment, the leverclutch 300 and spring 80 are either attached to each other or formed asa single structure and may be formed of identical or varying materialsand thicknesses.

The frictional edges 310 permit distal movement of the cap 20 withrespect to the wire 12 as the wire 12 moves through the central axis 308of the cap 20 and forces or biases the locking lever clutch 300 to moveupwards towards the cover 70, towards a plane that is closer to parallelwith the plane of the spring 80, and in an orientation that permits thebody of the wire 12 to move through the hole 304 with less frictionalcontact against the frictional edges 310. In contrast, the frictionaledges 310 resist proximal movement of the cap 20 with respect to thewire 12 as the wire 12 moves through the central axis 308 of the cap 20and forces or biases the locking lever clutch 300 to move downwards awayfrom the cover 70, towards a plane that is closer to perpendicular withthe plane of the spring 80, and in an orientation that resists movementof the body of the wire 12 through the hole 304 as the frictional edges310 are forced against and in increasing frictional contact with theouter surface of the body of the wire 12.

The embodiment of a cap 20 described with reference to FIGS. 2H, 2I, and2J can be unlocked during or after initial implantation to makeadjustments to, replace, or remove any or all of the system 1. To unlockthe lever clutch 300 of the cap 20, a user may manually, or by means ofa special hook-like tool, raise a handle 312 of the clutch 300, forexample, by exerting force on a lower edge 314 of the handle 312 in adirection that releases the friction edges 310 from their lockingposition with respect to the outer surface of the wire 12.

Extractor/Driver 90, with reference to FIGS. 5A and 5B, includes anydevice suitably configured to insert and/or extract cap 20. In oneembodiment, extractor 90 includes one or more ball bearings 91, shaft95, shaft end 93, handle 92 which receives shaft end 93, tip sleeve 94,tip 96, and/or spring 97. Tip 96 may be the end of a long rod whichextends upward into handle 92. Spring 97 applies pressure against theupper end of the rod that emanates from tip 96, thereby asserting a loadagainst tip 96. Tip 96 is thus configured to be received into inlet 74of cap 20 and the spring-load maintains tip 96 in inlet 74. Tip sleeve94 is configured to receive cap 20 to also facilitate rotation and/ortranslation of cap 20. Tip 96 is mounted on a disc such that it allowstip sleeve 94 to more fully receive cap 20. The disc also rotates suchthat extractor 90 may rotate around cap 20, with minimal or no movementof tip 96. Ball bearings 91 are configured to facilitate rotation of tipsleeve 94 around outer surface of cap 20.

Another embodiment of extractor/driver 90 is shown in FIG. 5C. In thisalternative embodiment, the rod may have a first end which includes tip96, and a second end 98 which may exit handle 92 such that the user mayapply pressure to the second end 98 of the rod, thereby similarlyapplying pressure and a load against tip 96. Exit handle 92 also rotatessuch that it enables rotation of tip 96 which allows the user to rotatetip 96 until tip 96 mates with the inlet in cap 20. In anotherembodiment, collet sleeve 99 is attached to collet advancing handle 89.Collet advancing handle 89 includes a threaded inner surface which isconfigured to advance shaft 95, and thus, advance collet sleeve 99forward over cap 20 to facilitate grasping of cap 20 for removal of cap20.

A tensioner 50 may also be used in conjunction with the presentinvention. With respect to FIG. 3A, tensioner 50 is any device suitablyconfigured to insert a cap 20 into an object and/or provide tension to awire 12. In one embodiment, tensioner 50 increases the pressure betweenthe surfaces of pathology by providing force to a wire 12 while theanchor component 2 of wire 12 is fixed into a bone or far cortex. In anexemplary embodiment, tensioner 50 includes a handle 52 with a handtrigger 54, wherein the handle 52 supports a rotatable barrel 56 whichmates with a cylindrical rod 58. Cylindrical rod 58 may be cannulated toreceive wire 12 and/or have a driver 60 (e.g., hex, phillips, screw,allen and/or the like) at its distal end for mating with the toolattachment 10 of anchor component 2. The barrel 56 may be rotatedmanually or automatically in order to rotate the driver 60 into theobject (e.g., bone or cortex). In one embodiment, tensioner 50 includesa means for exerting a force on wire 12, such as, for example, internalgears 64, wherein the gears 64 include an interface component 66 (e.g.,saw tooth) which mate with the inverse sawtooth 20 on wire 12. Bypivoting the hand trigger 54, the internal gears are rotated such thatthe gears cause wire 12 to translate out the back end 62 of thetensioner 50, thereby exerting force on wire 12 which is fixed at itsdistal end. The tensioner 50 may also include a gauge type device or anyother device which is suitably configured to measure and/or display thetension exerted on wire 12.

Another embodiment of a tensioner (e.g., tensioner 101) is shown in FIG.3B. In one embodiment, tensioner 100 includes a base 101, a DVR connectcomponent 102, a handle 103, a lock 104, and/or a spring link 106.Tensioner 100 is configured to accept multiple size wires and mayinclude an indicator to show the amount of tension being applied.Tensioner 101 is also configured such that extractor 90 may clip intotensioner 101.

After tensioning wire 12 to the desired tension, wire 12 may be cut,broken or shortened using any known device or method. With reference toFIG. 6, cutter 200 may be used. Cutter 200, in one embodiment, includesinsert left 201, insert right 202, jaw left 203, jaw right 204, cutterleft 205, and cutter right 206. Cutter 200 includes a cutting surfacethat extends beyond the main body of cutter 200 such that the wire maybe cut from various angles.

The various components discussed herein can be suitably configured toperform the following method, wherein the steps can be performed in anyorder and any individual step is not necessary to the method. In anexemplary embodiment, a cannulated lagwire driver is suitably attachedto a surgical drill, such that the drill allows for automatic rotationof the driver. The wire 12 of lagwire system 1 is placed into thechannel of the driver such that the end of the driver encompasses or isreceived into driver head 10 of anchor component 2, thereby allowingwire 12 to be drilled into the bone. In one embodiment, anchor component2 is configured with a hex head as the driver head 10 such that thedriver suitably mates to the hex head. The anchor component 2 and wire12 are then drilled into the bone to a desired depth using the automaticsurgical drill (or any other manual or automatic device for rotatinganchor component 2). Specifically, drill tip 4 of anchor component 2facilitates the drilling of a pilot hole, wherein the proximal cuttingthreads 6 tap the bone for threading the inner surface of the hole, thenthe proximal mating threads 8 rotationally mate with the newly createdthreaded surface, thereby temporarily attaching the anchor component 2into the cortex of the bone.

After attaching the anchor component 2 to the bone, the surgical drillis removed and a cap 20 is threaded onto the proximal end 14 of wire 12.Cap 20 is then translated distally along wire 12 until cap 20 contactsthe bone or other desired pathology. In one embodiment, a lagwiretensioner is used to exert tension on the lagwire. In anotherembodiment, a lagwire tensioner 50 may be used to force or seat cap 20into the bone surface or any other desired position. The hex head 60 ofthe tensioner 50 may be used to screw cap 20 into the bone surface. Inanother embodiment, the lagwire tensioner 50 exerts tension on thelagwire 12 up to a desired tension which may be read from a gaugecommunicating with the tensioner.

After positioning the lagwire device 1 and applying the appropriateamount of tension, in one embodiment, the excess wire 12 may be suitablyremoved by, for example, a wire cutter or any other suitable device. Inanother embodiment, a crimp type device may be placed on wire 12 to alsohelp maintain tension. The crimp may include a clamp type device,bending the existing wire 12, screwing a nut onto the end of wire 12and/or the like. The crimp may be placed on wire 12 after cap 20 is setin place, for example, in order to crimp other end pieces together. Thetensioner 50 may also be used to reverse screw cap 20 in order to removea wire 12 out of the bone. Moreover, in a situation where anchorcomponent 2 strips out of the bone (for example, when the bone is ofpoor quality), the present invention allows the lagwire to be pushedthrough the opposite side of the bone and through the skin such that theanchor component 2 of wire 12 can be suitably removed (e.g., cut off)and a cap 20 can be placed onto that end of the lagwire, therebyresulting in better purchase (e.g., quality of fixation) of the bone.

With respect to FIGS. 4A-4G, the lagwire system discussed herein can beused for the fixation of various types of bone fractures. FIG. 4A showsthe use of the present invention for an exemplary fixation of a bonefracture or break. FIGS. 4B-4D show the use of the present invention foran exemplary fixation of fractures of certain portions of bones.Moreover, as shown in exemplary FIGS. 4F and 4G, the lagwire system 1may also be used in a similar manner discussed herein in order to assistin holding a plate to the bone to help fix certain types of fractures.In other types of fractures, the lagwire may be placed through an entirelimb to, for example, attach an external fixation device to the limb asshown in exemplary FIG. 4E.

FIG. 4H shows a fixation of a vertebrae in accordance with an exemplaryembodiment of the present invention. The screw is inserted into thevertebrae, then a cap is fitted onto the end of the wire. The cap isspecially constructed such that the cap attaches to a rod. The rod mayextend along various vertebrae such that the lagwires may extend fromvarious vertebrae and all connect to the same rod. Another screw andlagwire may be inserted into the other side of the vertebrae such thatthe wire extends from the other side of the vertebrae and its capconnects to a second rod on the other side of the vertebrae foradditional stability.

As described herein, the system and method of the present inventionprovides a device which is self-drilling, self-tapping and can beinserted under power. The invention also facilitates reducing and fixingfractures in one step. As such, the invention substantially expeditesthe process for fixation of bone fractures which is, of course, criticalduring trauma situations in order to stabilize a patient or to minimizethe amount of time the patient is on the operating table or underanesthesia. In contrast to typical prior art screws wherein a glidinghole in the near cortex simply guides the screw, the present inventionprovides the ability for two sides of cortex bone screw fixation.Moreover, because of the strength of the attachment to the bone, theinvention enables sufficient fixation even in poor quality bonematerial. Furthermore, wherein the prior art systems often require theuse of cannulated screws in order to utilize a guidewire for placement,the present invention does not require the use of cannulated screws.Because the lagwire includes a tip 4 which creates a pilot hole, tapsthe bone for threads and fixes the threads into the bone, the system andmethod minimizes the possibility of inaccurate placement into the distalcortex or missing the distal hole.

In prior art systems, the physician typically cuts a relatively largeopening in the skin in order to locate the bone segments, pull the bonesegments into alignment, then place the screw into the bones. In thepresent invention, the system facilitates the percutaneous technique byallowing the physician to cut a minor incision into the skin for theanchor component, insert the anchor component, then pull the bonestogether with wire 12 and set the cap, all without large incisions oradditional incisions.

Another embodiment for a bone fixation device includes a collapsing bonefixation device which is suitably configured to collapse in associationwith a fracture collapse to minimize or prevent the device fromprotruding beyond the bone. In an exemplary embodiment, the bonefixation device also includes an internal (i.e., minimal or no contactwith the bone) compressive device 140 to maintain compression across thefracture during fracture collapse (e.g., weight bearing by the patient).

With respect to FIG. 7, an exemplary embodiment includes an improvedscrew 100 having a sleeve 110 and a shaft 130. In one embodiment, noadditional elements exist between sleeve 110 and shaft 130, but in otherembodiments (as discussed below in more detail and in FIGS. 8 and 9), acompressive device 140 (e.g. spring) is located between sleeve 110 andshaft 130. In an exemplary embodiment, each of the elements sleeve 110,shaft 130, and compressive device 140 are cannulated.

In one embodiment, with respect to FIG. 7, shaft 130 includes a firstend 132 having a gripping device 133 and a second end 134. Grippingdevice 133 may include any structure and configuration for enablingshaft to enter and attach to an object. In one embodiment, grippingdevice includes a threaded surface thereon. The threaded surface mayinclude cutting threads, mating threads, barbs, ribbed surface or anyother surface configured to retain shaft 130 into an object. In anexemplary embodiment, gripping device 133 is about 0.63 inches in lengthwith a pitch of about 9 threads per inch.

In one embodiment, shaft 130 is generally cylindrical, but includes oneor more flat outer surfaces 135. In a particular embodiment, second end134 includes two rectangular flat, opposing surfaces which extend overthe entire length of shaft 130, but terminate prior to gripping device133. In an exemplary embodiment, the flat surfaces of shaft 130 are eachabout 1.25 inches in length.

In one embodiment, second end 134 of shaft 130 is configured to restrictshaft 130 from translating beyond a particular location with respect tothe sleeve 110. In an exemplary embodiment, end cap 136 is located on ornear second end 134, and is formed in a cylindrical configuration suchthat end cap 136 freely translates within the cylindrical portion ofsleeve 110, but end cap 136 stops the translation of shaft 130, when endcap 136 impacts the flat inner surface of sleeve 110. End cap 136 limitsthe expansion of compressive device 140 to a certain point, so continuedcompression can be applied against the fracture. End cap 136 may beintegral with shaft 130, welded onto shaft 130, or otherwise affixed toshaft 130.

With continued reference to FIG. 7, a wider diameter head 112 is locatedat the first end of sleeve 110. An exemplary diameter of head 112 isabout 0.387 inches. Head 112 includes a recessed portion for receivingthe hex head of a tool. One skilled in the art will appreciate that head112 may be any configuration suitably configured to receive any suitableworking tool. The recessed portion is about 0.10 inches in depth andabout 0.198 inches wide. Head 112 (or any other portion of sleeve 110)may also include a ledge 114 (FIG. 8) for retaining compressive device140 within sleeve 110. Cap 20 (discussed above in other embodiments) maybe configured as sleeve 110 (or barrel) and any components of cap 20 maybe incorporated into bone screw 100.

A second end of sleeve 110 includes an opening 116 which receives shaft130 such that shaft 130 is able to at least partially move within sleeve110, with minimal or no movement of sleeve 110. As discussed above, inone embodiment, the inner surface of sleeve 110 is generallycylindrical, but the inside surface also includes two rectangular flat,opposing surfaces which extend along a portion of the length of sleeve110. In an exemplary embodiment, the overall sleeve 110 is about 1.85inches long, about 0.22 inches outer diameter, and about 0.161 innerdiameter with a reduced distance between the flat surfaces of about 0.14inches with the flat surfaces of sleeve 110 being each about 0.545inches in length.

In one embodiment, and with respect to FIG. 8, a compressive device 140exists between sleeve 110 and shaft 130 such that compressive device 140exerts a force directly or indirectly against shaft 130. Compressivedevice 140 may include, for example, a spring or any other element whichexerts a force and/or bears a load. In one embodiment, compressivedevice 140 is located inside sleeve 110 (as discussed above). In aparticular embodiment, compressive device 140 is a spring having about10 mm of extension. As such, compressive device 140 allows about 10 mmof compression before sleeve head 112 is no longer held against thecortex.

Compressive device 140 may be suitably affixed to sleeve 110 and shaft130 in any manner known in the art. In an exemplary embodiment, firstend of compressive device 140 includes a larger diameter coil which sitsupon ledge 114 of head 112, thereby restricting or minimizingtranslation of compressive device 140 within sleeve 110. The largerdiameter coil may also be further retained by a C-clip or laser weldingto sleeve 110 (e.g., at any location within the first end).

Second end of compressive device 140 may include a tang 142. Tang 142may extend longitudinally from the perimeter of the end coil. Tang 142may be crimped into a hole in shaft 130, laser welded to the end ofshaft 130 and/or any other means for attaching tang 142 to shaft 130. Inother embodiments, shaft 130 may abut compressive device 140,compressive device 140 may receive shaft 130 within its coils, orcompressive device 140 may abut a component attached to shaft 130. Forexample, compressive device 140 may be a separate component suitablyjoined (e.g., welded, glued, molded) to shaft 130 and/or end cap 136.

Locating compressive device 140 inside sleeve 110 is significantlyadvantageous because the compressive device is fully or partiallyprotected from bone growth over and between the coils which may limit ordestroy the functionality of the spring. Similarly, a re-absorbablematerial is not needed to be inserted between the coils in order todelay the compressive action of the spring. In other words, uponinsertion, compressive device 140 is able to provide immediate andsubsequent compression. Moreover, because shaft 130 and sleeve 110rotate along with compressive device 140, bone screw device 100 may beinserted or removed with minimal or no torque or unraveling ofcompressive device 140.

Multiple bone screws 100 of the present invention may also be used forrotational stability. For example, as set forth in FIG. 10, more thanone bone screw (e.g., three) may be used to maintain compression andprovide rotational stability in a fracture within the head of the femurbone.

Bone screw 100 of the present invention may be used in place of anyexisting bone screw, or any existing component of a product thatperforms a similar function as a bone screw. With respect to FIG. 11,bone screw 100 is used in association with an intermedulary rod foradditional support and stability.

With respect to FIG. 12, bone screw 100 is incorporated into acompression/dynamic hip screw system 150 which may be used on, forexample, a proximal femur fracture. An exemplary hip screw system 150may include any combination of the various compression hip screw platesand nails manufactured by Smith & Nephew. In one embodiment, bone screw100 is received into barrel 152 of hip screw system 150 in place of thestandard bone screw which is typically received into barrel 152. Barrel152 may or may not include an additional compressive device 140. Inanother embodiment, barrel 152 may act as a second sleeve 110, therebyadding to the available translation of shaft 130. In other words, shaft130 translates within sleeve 110, and sleeve 110 itself may translatewithin barrel 152 before hip screw system 150 protrudes from the bone.In a further embodiment, sleeve 110 is affixed directly to plate 155, soa barrel is not needed.

Hip screw system 150 (with standard plate 155 and cortical bone screws)is inserted as is known in the art, and the features of the presentinvention incorporated into hip screw system 150 provide additionalbenefits by minimizing or preventing the device from protruding beyondthe bone, and by maintaining an additional amount of compression acrossthe fracture during fracture collapse. A T-Handle may be used to rotatebone screw 100 into the bone. One skilled in the art will appreciatethat bone screw 100 may replace or supplement any of the screws (e.g.,cortical bone screws, medial fragment screws and/or main bone screw)typically used in association with hip screw system 150.

FIG. 13 shows another embodiment of hip screw system 150, wherein shaft130 is received directly into barrel 152 of existing hip screw system150, without the need for a separate sleeve 110. A standard barrel 152may be used or a longer opening formed within barrel 152 to allow shaft130 greater translation within barrel 152. Barrel 152 may also includeany of the features and functions described above with respect to sleeve110. For example, barrel 152 may include one or more flat inner portionsto complement flat portion 135 of shaft 130, a ledge 114 to hold a widerdiameter spring, etc. Any of the hip screw systems may or may notincorporate a compressive device 140 inside sleeve 110 or barrel 152.Without compressive device 140, barrel 152 and/or sleeve 110 is stillconfigured to allow shaft 130 to collapse within barrel 152 and/orsleeve 110, as discussed above.

Compression screw 157 is inserted through plate 155, through barrel 152and into shaft 130. Upon rotating or translating compression screw 157through barrel 152, the head of compression screw 157 engages (or abuts)a recessed portion of plate 155 and/or a recessed portion of barrel 152.Upon continuing to rotate compression screw 157, shaft 130 is “pulled”back into barrel 152, thereby causing further compression. In anotherembodiment, compression screw 157 is also received through compressivedevice 140 which itself resides in barrel 152 and/or sleeve 110. Uponreceiving a weight bearing load, hip screw system 150 allows shaft 130to translate with minimal or no protrusion of hip screw system 150beyond the bone, and also, maintaining an additional amount ofcompression across the fracture during fracture collapse.

With respect to FIG. 14, another exemplary embodiment includes animproved screw 100 having a sleeve 110 and a shaft 130. In oneembodiment, no additional elements exist between sleeve 110 and shaft130, but in other embodiments (as discussed below in more detail and inFIGS. 15 and 17), a compressive device 140 (e.g. split washer) islocated between sleeve 110 and shaft 130. In an exemplary embodiment,each of the elements sleeve 110, shaft 130, and compressive device 140may be cannulated.

In one embodiment, with respect to FIG. 15, shaft 130 includes a firstend 132 having a gripping device 133 and a second end 134. Grippingdevice 133 may include any structure and configuration for enablingshaft to enter and attach to an object. In one embodiment, grippingdevice includes a threaded surface thereon. The threaded surface mayinclude cutting threads, mating threads, barbs, ribbed surface or anyother surface configured to retain shaft 130 into an object. In anexemplary embodiment, gripping device 133 is about 0.63 inches in lengthwith a pitch of about 14.3 threads per inch.

In one embodiment, second end 134 of shaft 130 is configured to restrictshaft 130 from translating beyond a particular location with respect tothe sleeve 110. In an exemplary embodiment, end cap 136 is located on ornear second end 134, and is formed in a cylindrical configuration suchthat end cap 136 freely translates within the cylindrical portion ofsleeve 110, but end cap 136 stops the translation of shaft 130 when abottom edge 144 of end cap 136 compresses compressive device 140 againsta flat inner surface or ledge 114 of sleeve 110. An exemplary diameterof end cap 136 is about 0.22 inches.

End cap 136 includes a recessed portion for receiving the hex head of atool. One skilled in the art will appreciate that end cap 136 may be anyconfiguration suitably configured to receive any suitable working tool.The recessed portion is about 0.1 inches in depth and about 0.12 incheswide. End cap 136 may include an axial length that is shorter than theaxial length of the cylindrical portion of sleeve 110, such that end cap136 may move within a range of distance capable of compressing,extending, and moving out of and into communication with compressivedevice 140 without exiting the chamber of the cylindrical portion ofsleeve 110. This range of distance will ensure that compression from thefracture of an object, such as a bone, causing the shaft 130 to movetowards the sleeve 110, will not cause the end cap 136 to exit thechamber within the cylindrical portion of sleeve 110, thereby avoiding aprotruding end cap 136 from causing injury or inconvenience to a patientor other user of the screw 100. End cap 136 ensures the compression ofcompressive device 140 so continued compression can be applied againstthe fracture. End cap 136 may be integral with shaft 130, welded ontoshaft 130, or otherwise affixed to shaft 130.

With continued reference to FIG. 15, a head 112 with a diameter widerthan the end cap 136 may be located at the first end of sleeve 110.Alternatively, sleeve 110 may not include head 112. Rather, sleeve 110may merely rest flush with an object, such as a bone, without having anyridge resting on the exterior surface of the object. An exemplarydiameter of head 112 is about 0.4 inches. In one exemplary embodiment,head 112 includes a bottom edge 148 that abuts against the exteriorsurface of an object, such as a bone, bone plate 155 (FIG. 13), orbarrel 152. In another embodiment, sleeve 110 may be formed as a barrel152. Head 112 (or any other portion of sleeve 110) may also include aledge 114, as previously identified, for retaining compressive device140 within sleeve 110. Cap 20 (discussed above in other embodiments) maybe configured as sleeve 110 (or barrel) and any components of cap 20 maybe incorporated into bone screw 100.

A second end of sleeve 110 includes an opening 116 which receives shaft130 such that shaft 130 is able to at least partially move within sleeve110, with minimal or no movement of sleeve 110. In an exemplaryembodiment, the chamber within the cylindrical portion of the overallsleeve 110 is about 7 mm long, and the overall sleeve 110 is about 0.3inches wide at the outer diameter, and about 0.21 inches wide at theinner diameter. In an exemplary embodiment, the overall end cap 136located within the chamber of the cylindrical portion of sleeve 110 isabout 2.5 mm long and about 0.21 inches wide at the outer diameter.

In one embodiment, and with respect to FIGS. 16 and 17, a compressivedevice 140 exists between sleeve 110 and shaft 130 such that compressivedevice 140 exerts a force directly or indirectly against shaft 130.Compressive device 140 may include, for example, a spring, split washer,or any other element which exerts a force and/or bears a load. In oneembodiment, compressive device 140 is located inside sleeve 110 (asdiscussed above). In a particular embodiment, compressive device 140 isa split washer having about 1 mm of expansion and compression formed ina helical shape. As such, compressive device 140 allows about 1 mm ofcompression before end cap 136 fully compresses compressive device 140,or, conversely, about 1 mm of extension before end cap 136 fully relaxescompressive device 140. When end cap merely rests against relaxed andfully extended compressive device 140, there is approximately 1 mm ofdistance between the outer surface of end cap 136 and the outer surfaceof sleeve head 112. Compressive device 140 is shown either relaxed andin contact with end cap 136 or at least partially compressed in FIG. 17such that sleeve 110 and shaft 130 are at least in contact with orindirectly exerting force against each other. In its partiallycompressed state, compressive device 140 permits end cap 136 to recedewithin the cavity or chamber formed within the cylindrical portion ofsleeve 110, as shown in FIG. 16.

Having described exemplary components of the invention, exemplarymethods for inserting bone screw 100 will now be described. An exemplarymethod for inserting bone screw 100 comprises drilling a bore hole intothe two objects (e.g., two pieces of the fractured bone) which are to becompressed together. In an exemplary method used in conjunction with thebone screw 100 described with reference to FIGS. 14 through 17, one ormore coaxial bore holes may be drilled, having different diameters anddepths in order to accommodate the insertion of a sleeve 110 having awider diameter and shorter depth than a shaft 130 having a narrowerdiameter and longer depth. A guide rod may be inserted into the borehole, then bone screw 100 may be inserted over the guide rod. Eitherhead 112 (FIGS. 7 through 9) or end cap 136 (FIGS. 14 through 17),depending upon the embodiment employed, of bone screw 100 is thenrotated (e.g. using a drill, hex head driver, or other suitable device)into and through the proximal bone portion or fragment. Head 132 ofshaft 130 then enters the distal bone portion or fragment. When sleeve110 impacts or sits flush against the surface of the proximal boneportion or fragment (or against a plate placed over the bone portion orfragment), either head 112 (FIGS. 7 through 9) or end cap 136 (FIGS. 14through 17), depending upon the embodiment employed, of sleeve 110continues to rotate, but sleeve 110 no longer translates into the bone.However, the rotation of sleeve 110 or end cap 136, depending upon theembodiment employed, continues to advance shaft 130 further into thedistal bone portion or fragment because threads of gripping device 133move shaft 130 forward. Such continued translation and penetration ofshaft 130 into the distal bone portion or fragment also extendscompressive device 140 (as best shown in FIG. 9) or compressescompressive device 140 (as best shown in FIGS. 16 and 17), dependingupon the embodiment employed. In other words, the continued advance ofshaft 130 causes compressive device 140 to stretch beyond its relaxedcondition (as shown in FIG. 9) or compress from its relaxed helicalcondition towards a flat condition (as shown in FIG. 17). After the bonescrew is appropriately inserted, the guide rods are removed.

One skilled in the art will appreciate that shaft 130 may penetrate intothe distal bone portion or fragment any desired partial or fulldistance, and thus, extend or compress, as applicable, compressivedevice 140 to any desired partial or full extension, compression, orforce. One skilled in the art will appreciate that any “rotationalinsertion” discussed herein may alternatively or additionally includeother means for insertion such as, for example, a direct translationusing a hammer to force the shaft and/or sleeve into the bone.

After insertion of bone screw 100, compressive device 140 exerts forceagainst sleeve 110 and shaft 130, thereby forcing the components eithertoward or away from one another, depending upon the embodiment employed.Such force helps to maintain the compressive load at the union of thefracture. As additional compression is exerted on the load in a fracturecollapse (e.g., from weight bearing), the bone is compressed closertogether, so force may be reduced. However, the present invention eithercollapses or expands, as applicable, in association with the fracturecollapse to substantially minimize or prevent sleeve head 112 of bonescrew 100 (FIGS. 7 through 9) from protruding beyond the bone or tosubstantially minimize or prevent end cap 136 of bone screw 100 (FIGS.14 through 17) from protruding beyond the chamber within the cylindricalportion of head 112. In other words, sleeve head 112 is substantiallymaintained against the lateral cortex, while compressive device 140maintains compression across the fracture during fracture collapse. Thatis, as the bone portions or fragments undergo stress relaxation, bonescrew 100 similarly relaxes, while continuing to hold the portions orfragments together. As such, bone screw 100 continues to accommodate thestress relaxation of the bone portions or fragments until the fracturetherebetween has significantly or completely healed.

As discussed above, in one embodiment, compressive device 140 is aspring having about 10 mm of extension. As such, the spring allows about10 mm of compression before shaft 130 impacts sleeve 110 so that sleevehead 112 is forced away from the cortex. Sleeve head 112 may bemaintained against the lateral cortex until a sufficient amount of forceno longer exists within compressive device 140, then bone screw 100 maysimply act as a traditional bone screw.

As also discussed above, in another embodiment, compressive device 140is a split washer having about 1 mm of compression. As such, the splitwasher allows about 1 mm of extension before end cap 136 of shaft 130moves away from compressive device 140 in a direction towards the exitof the chamber of the cylindrical portion of sleeve 110. Unlike theembodiment discussed with reference to FIGS. 7 through 9, the embodimentdiscussed with reference to FIGS. 14 through 17 provides an additionaladvantage of permitting the shaft 130 to move fully exit sleeve 110without ever forcing sleeve 110 or sleeve head 112 away from the cortex.As with the embodiment discussed with reference to FIGS. 7 through 9,the embodiment discussed with reference to FIGS. 14 through 17 providesa sleeve head 112 that may be maintained against the lateral cortexuntil a sufficient amount of force no longer exists within compressivedevice 140, then bone screw 100 may simply act as a traditional bonescrew.

The present invention is described herein in connection with thefixation of bone fractures; however, one skilled in the art willappreciate that the lagwire or bone screw system and method describedherein may also be used for changing, maintaining, reducing or expandingthe distance between objects, object portions, or surfaces, compressingobjects or object portions together, or providing pressure to surfaces.For example, the present invention may be used to repair wood products,tree limb damage, breaks in supports or columns, cracks in sculptures orbuildings, fractures in sections of concrete or other buildingmaterials, cracks or breaks in car parts and/or the like.

In the foregoing specification, the invention has been described withreference to specific embodiments. Various modifications and changes canbe made, however, without departing from the scope of the presentinvention as set forth in the claims below. The specification andfigures are to be regarded in an illustrative manner, rather than arestrictive one, and all such modifications are intended to be includedwithin the scope of present invention. Accordingly, the scope of theinvention should be determined by the appended claims and their legalequivalents, rather than by the examples given above. For example, thesteps recited in any of the method or process claims may be executed inany order and are not limited to the order presented in the claims.

Benefits, other advantages, and solutions to problems have beendescribed herein with regard to specific embodiments. However, thebenefits, advantages, solutions to problems, and any elements that maycause any benefit, advantage, or solution to occur or become morepronounced are not to be construed as critical, required, or essentialfeatures or elements of the invention. The scope of the invention isaccordingly to be limited by nothing other than the appended claims, inwhich reference to an element in the singular is not intended to mean“one and only one” unless explicitly so stated, but rather “one ormore.” Moreover, where a phrase similar to ‘at least one of A, B, and C’is used in the claims, it is intended that the phrase be interpreted tomean that A alone may be present in an embodiment, B alone may bepresent in an embodiment, C alone may be present in an embodiment, orthat any combination of the elements A, B and C may be present in asingle embodiment; for example, A and B, A and C, B and C, or A and Band C. All structural, chemical, and functional equivalents to theelements of the above-described exemplary embodiments that are known tothose of ordinary skill in the art are expressly incorporated herein byreference and are intended to be encompassed by the present claims.Further, a list of elements does not include only those elements but mayinclude other elements not expressly listed or inherent to such process,method, article, or apparatus.

The invention claimed is:
 1. A fracture compressive system comprising: asleeve comprising a proximal sleeve portion and a distal sleeve portion;a shaft comprising a distal shaft portion, a proximal shaft portion, anda body portion; and a compressive device engaged between the sleeve andthe shaft, wherein the sleeve is configured to contact a first boneportion, wherein an exterior of the distal shaft portion is configuredto anchor into a second bone portion, wherein the proximal shaft portionof the shaft is received within the sleeve such that shaft and sleevemove longitudinally relative to one another, wherein the shaft isconfigured to limit the outward longitudinal movement of the shaft andwherein the shaft is configured to limit the inward longitudinalmovement of the shaft.
 2. The system of claim 1, further comprising astop cap, wherein the stop cap attaches to the proximal shaft portion.3. The system of claim 2, wherein the sleeve includes a surface whichforms a ridge on the inside surface of the sleeve, and wherein the shaftincludes a flat surface such that the ridge impacts a distal portion ofthe stop cap to limit the outward longitudinal movement of the shaft. 4.The system of claim 3, wherein the ridge impacts a distal portion of theflat surface to limit the inward longitudinal movement of the shaft. 5.The system of claim 1, wherein the proximal end of the sleeve comprisesa recessed region comprising a ledge, and wherein the compression devicehas one end abutting the ledge.
 6. The system of claim 1, wherein thecompressive device is configured to shorten in direct relationship withcollapse of the shaft relative to the sleeve.
 7. The system of claim 1,wherein the shaft, the sleeve and the compressive device cannot moverotationally relative to one another.
 8. The system of claim 1, whereinthe compressive device substantially maintains compression across thefracture during the collapse of the fracture, wherein the shaft isconfigured to be substantially maintained at least partially within thesecond bone and at least partially within the sleeve during the collapseof the fracture, until a sufficient amount of force no longer existswithin the compressive device.
 9. The system of claim 1, wherein atleast one of the sleeve, the stop cap, the shaft, or the compressivedevice are cannulated.
 10. The system of claim 1, wherein a distance theshaft can travel in the sleeve is greater than a distance the first boneportion and the second bone portion can collapse against one another,such that the shaft is substantially maintained at least partiallywithin the second bone portion and at least partially within the sleeveduring a collapse of a fracture.
 11. The system of claim 1, wherein thecompressive device exerts a force over a longer distance than acollapsible distance between the first bone and the second bone.
 12. Thesystem of claim 1, wherein the system acts as a traditional bone screwin response to a sufficient amount of force no longer existing withinthe compressive device.
 13. The system of claim 1, wherein thecompressive device substantially maintains compression across thefracture during the collapse of the fracture.
 14. The system of claim 1,wherein the system acts as a traditional bone screw in response to theshaft collapsing into the sleeve.
 15. The system of claim 1, wherein thesleeve is configured with threads on an outside surface of the sleeve tofacilitate rotating the sleeve at least partially into the first boneportion.
 16. The system of claim 1, wherein the compressive device isfully enclosed within the sleeve.
 17. The system of claim 1, wherein thecompressive device is configured to at least one of: exert a distalforce against the sleeve and resist proximal movement of the sleeve. 18.The system of claim 1, wherein the compressive device is a helicalspring.
 19. The system of claim 1, wherein a distal end of thecompressive device includes a tang fixedly attached to a stop cap.